TY - JOUR
T1 - Diagnosis of atypical carcinoid can be made on biopsies > 4 mm2 and is accurate
AU - Reuling, Ellen M. B. P.
AU - Naves, Dwayne D.
AU - Daniels, Johannes M. A.
AU - Dickhoff, Chris
AU - Kortman, Pim C.
AU - Broeckaert, Mark A. M. B.
AU - Plaisier, Peter W.
AU - Thunnissen, E.
AU - Radonic, Teodora
N1 - Funding Information: This study was supported by a grant of ORAS (Oncological Research Albert Schweitzer Hospital). Publisher Copyright: © 2022, The Author(s).
PY - 2022/3
Y1 - 2022/3
N2 - In the 2021 WHO thoracic tumors, gradation of lung carcinoids in biopsies is discouraged. We hypothesized that atypical carcinoid (AC) could be reliably diagnosed in larger preoperative biopsies. Biopsy-resection paired specimens of carcinoid patients were included, and definitive diagnosis was based on the resection specimen according to the WHO 2021 classification. A total of 64 biopsy-resection pairs (26 typical carcinoid (TC) (41%) and 38 AC (59%)) were analyzed. In 35 patients (55%), tumor classification between the biopsy and resection specimen was concordant (26 TC, 9 AC). The discordance in the remaining 29 biopsies (45%, 29 TC, 0 AC) was caused by misclassification of AC as TC. In biopsies measuring < 4 mm 2, 15/15 AC (100%) were misclassified compared to 14/23 AC (61%) of biopsies ≥ 4 mm 2. Categorical concordance of Ki-67 in biopsy-resection pairs at threshold of 5% was 68%. Ki-67 in the biopsy was not of additional value to discriminate between TC and AC, irrespective of the biopsy size. Atypical carcinoid is frequently missed in small bronchial biopsies (< 4 mm 2). If the carcinoid classification is clinically relevant, a cumulative biopsy size of at least 4 mm 2 should be considered. Our study provides strong arguments to make the diagnosis of AC in case of sufficient mitosis for AC on a biopsy and keep the diagnosis “carcinoid NOS” for carcinoids with ≤ 1 mitosis per 2 mm 2. Ki-67 has a good concordance but was not discriminative for definitive diagnosis.
AB - In the 2021 WHO thoracic tumors, gradation of lung carcinoids in biopsies is discouraged. We hypothesized that atypical carcinoid (AC) could be reliably diagnosed in larger preoperative biopsies. Biopsy-resection paired specimens of carcinoid patients were included, and definitive diagnosis was based on the resection specimen according to the WHO 2021 classification. A total of 64 biopsy-resection pairs (26 typical carcinoid (TC) (41%) and 38 AC (59%)) were analyzed. In 35 patients (55%), tumor classification between the biopsy and resection specimen was concordant (26 TC, 9 AC). The discordance in the remaining 29 biopsies (45%, 29 TC, 0 AC) was caused by misclassification of AC as TC. In biopsies measuring < 4 mm 2, 15/15 AC (100%) were misclassified compared to 14/23 AC (61%) of biopsies ≥ 4 mm 2. Categorical concordance of Ki-67 in biopsy-resection pairs at threshold of 5% was 68%. Ki-67 in the biopsy was not of additional value to discriminate between TC and AC, irrespective of the biopsy size. Atypical carcinoid is frequently missed in small bronchial biopsies (< 4 mm 2). If the carcinoid classification is clinically relevant, a cumulative biopsy size of at least 4 mm 2 should be considered. Our study provides strong arguments to make the diagnosis of AC in case of sufficient mitosis for AC on a biopsy and keep the diagnosis “carcinoid NOS” for carcinoids with ≤ 1 mitosis per 2 mm 2. Ki-67 has a good concordance but was not discriminative for definitive diagnosis.
KW - Atypical carcinoid
KW - Biopsy size
KW - Endobronchial therapy Ki-67
KW - Typical carcinoid
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85123825990&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/35089404
UR - http://www.scopus.com/inward/record.url?scp=85123825990&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00428-022-03279-7
DO - https://doi.org/10.1007/s00428-022-03279-7
M3 - Article
C2 - 35089404
SN - 0945-6317
VL - 480
SP - 587
EP - 593
JO - Virchows Archiv
JF - Virchows Archiv
IS - 3
ER -